Spina bifida

Overview

Board takeaway: Provide latex-free care, protect insensate areas during positioning, and assess shunt function; a VP or VA shunt alone does not require dental prophylaxis.

A neural tube defect in which the spinal column does not close fully.

In myelomeningocele, children often have:

• Lower-limb paralysis
• Bladder and bowel dysfunction
• Hydrocephalus with a shunt
• A high risk of latex allergy

How does Spina bifida affect dental management?

• Latex precautions: verify latex-free gloves, dam, prophy cups, and medical/dental equipment rather than assuming every product is safe.
• Emergency readiness: Maintain an anaphylaxis response plan.
• Scheduling limit: A first appointment is not a substitute for avoiding latex exposure.
• VP and VA shunts: routine dental antibiotic prophylaxis is not recommended for the shunt alone.
• When to consult: Consult the neurosurgeon when there is a clinical concern, suspected infection, or uncertainty about the device or medical status.
• Positioning: Wheelchair transfer or treatment in the wheelchair; pressure-sore precautions where sensation is absent
• Shunt function: Monitor for shunt failure signs: headache, vomiting, lethargy, irritability
• Home care: Prevention and caregiver training for home care

Exam pearl

What is Spina bifida?

A birth defect in which the spine and spinal cord do not form properly. In its most severe form, myelomeningocele, part of the spinal cord and nerves protrude through an opening in the back.

What are the main systemic features of Spina bifida?

• Mobility: Paralysis and loss of sensation below the level of the lesion; wheelchair use or braces
• Hydrocephalus: Hydrocephalus, often treated with a ventriculoperitoneal (VP) shunt
• Chiari II: Chiari II malformation; possible swallowing or breathing difficulties
• Bladder and bowel: Neurogenic bladder and bowel; frequent urinary tract infections and catheterization
• Latex: High rate of latex allergy from repeated exposure in early surgeries
• Learning: Learning difficulties in some; intelligence often normal
• Prevention: Prevented in part by maternal folic acid before and during early pregnancy

What oral findings occur in Spina bifida?

• Anatomy: No specific oral malformations
• Caries: Higher caries risk from medications (sugar-containing syrups), diet, and limited dexterity
• Reported findings: Malocclusion and enamel defects reported in some children

Why are children with spina bifida at risk of latex allergy?

• Mechanism: Repeated early exposure to latex through surgery, catheterization, and medical care sensitizes many children with spina bifida.
• Safety rule: Reactions range from contact dermatitis to life-threatening anaphylaxis, so latex avoidance is a safety rule, not a preference.

A child with myelomeningocele and a VP shunt needs an extraction. Is antibiotic prophylaxis needed?

• VP shunt: routine dental antibiotic prophylaxis is not warranted.
• VA shunt: this also is not a routine prophylaxis indication. Recent revision or concern about shunt infection/function calls for neurosurgical discussion of clinical stability, not an automatic antibiotic rule.
• Dental setting: plan latex-free care.

Sources

• Supplemental latex-avoidance guidance: Spina Bifida Association: Latex and Latex Allergy guideline (September 2023)
• AAPD dental guidance: AAPD: Antibiotic prophylaxis (2026 revision)
• Definition: MedlinePlus: Spina bifida
• Management of Dental Patients with Special Health Care Needs
• Antibiotic Prophylaxis for Dental Patients at Risk for Infection